Association Between the PRIMARY Score at Staging Prostate-specific Membrane Antigen Positron Emission Tomography and Overall Survival Among Patients with Newly Diagnosed Prostate Cancer: Findings from the International, Multicenter PROMISE Registry

The PRIMARY score was implemented in Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) version 2 to improve accuracy for the diagnosis of clinically significant prostate cancer using prostate-specific membrane antigen (PSMA) positron emission tomography (PET). We reviewed overall survival (OS) for patients who underwent PSMA PET for initial staging to evaluate the prognostic value of PRIMARY in a large, international, multicenter cohort. The cohort comprised 1889 patients who underwent PSMA PET for initial staging of prostate cancer at investigator sites across Europe and Australia between 2012 and 2021. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated for PRIMARY scores to identify predictors of OS. Complete-case head-to-head comparisons were conducted for Prostate Imaging-Reporting and Data System (PI-RADS) versus PRIMARY scores, and cT stage versus PRIMARY scores. We present preliminary findings up to January 31, 2025, when 231 deaths had occurred. PRIMARY score 5 (HR 1.5, 95% CI 1.0-2.3; p = 0.045) was associated with shorter OS. Improvements in C index values confirmed the added prognostic value of the PRIMARY score when combined with PI-RADS or cT stage. PRIMARY score 5 on initial PSMA PET is prognostic for shorter OS. There is ongoing long-term follow-up in the PROMISE registry (NCT06320223, promise-pet.org).

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Publication Details

Journal
European Urology
Published
2025-10-29
DOI
https://doi.org/10.1016/j.eururo.2025.10.013
Citations
4
Primary Topic
Prostate Cancer Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
6.07
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article

Association Between the PRIMARY Score at Staging Prostate-specific Membrane Antigen Positron Emission Tomography and Overall Survival Among Patients with Newly Diagnosed Prostate Cancer: Findings from the International, Multicenter PROMISE Registry

Sazan Rasul, Elin Trägårdh, Andrea Di Giorgio, Anders Bjartell et al.
4 citations
European Urology
Prostate Cancer Diagnosis and Treatment
6.07
article

Association Between the PRIMARY Score at Staging Prostate-specific Membrane Antigen Positron Emission Tomography and Overall Survival Among Patients with Newly Diagnosed Prostate Cancer: Findings from the International, Multicenter PROMISE Registry

Sazan Rasul, Elin Trägårdh, Andrea Di Giorgio, Anders Bjartell, Caner Civan, Ralph A. Bundschuh, Boris Hadaschik, Andrej Vondrák, Kambiz Rahbar, Francesco Lanfranchi, Jonathan Miksch, Lone Forner, Sebastian Hoberück, Lale Umutlu, Adrien Holzgreve, Isabel Rauscher, Louise Emmett, Narjess Ayati, Wolfgang P. Fendler, Michael S. Hofman, Osman Güven, Timo Soeterik, Laura Evangelista, Christian Thomas, Matthias J. Eiber, Ken Herrmann, Madeleine J. Karpinski, Helen Scholtissek
article en
4 citations

Abstract

The PRIMARY score was implemented in Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) version 2 to improve accuracy for the diagnosis of clinically significant prostate cancer using prostate-specific membrane antigen (PSMA) positron emission tomography (PET). We reviewed overall survival (OS) for patients who underwent PSMA PET for initial staging to evaluate the prognostic value of PRIMARY in a large, international, multicenter cohort. The cohort comprised 1889 patients who underwent PSMA PET for initial staging of prostate cancer at investigator sites across Europe and Australia between 2012 and 2021. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated for PRIMARY scores to identify predictors of OS. Complete-case head-to-head comparisons were conducted for Prostate Imaging-Reporting and Data System (PI-RADS) versus PRIMARY scores, and cT stage versus PRIMARY scores. We present preliminary findings up to January 31, 2025, when 231 deaths had occurred. PRIMARY score 5 (HR 1.5, 95% CI 1.0-2.3; p = 0.045) was associated with shorter OS. Improvements in C index values confirmed the added prognostic value of the PRIMARY score when combined with PI-RADS or cT stage. PRIMARY score 5 on initial PSMA PET is prognostic for shorter OS. There is ongoing long-term follow-up in the PROMISE registry (NCT06320223, promise-pet.org).

European UrologyVol. 89(2)
Humanitas University (IT), University of Augsburg (DE), Lund University (SE), Peter MacCallum Cancer Centre (AU), Constantine the Philosopher University in Nitra (SK), St Vincent's Hospital Sydney (AU), St. Antonius Ziekenhuis (NL), University Hospital Münster (DE), Essen University Hospital (DE), Skåne University Hospital (SE), University Hospital Ulm (DE), Molecular Theranostics (United States) (US), University Hospital Carl Gustav Carus (DE), IRCCS Humanitas Research Hospital (IT), Technical University of Munich (DE), Medical University of Vienna (AT), Technische Universität Dresden (DE), Ludwig-Maximilians-Universität München (DE), University of Genoa (IT), University of Bologna (IT)
Openalex Percentile: Top 3%
Prostate Cancer Diagnosis and Treatment
6.07
DOIOpen Access PDFOpenAlex
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